Responsible for application of appropriate medical necessity tools to maintain compliance and achieve cost effective and positive patient outcomes.
Acts as a resource to other team members including UR Tech and AA to support UR and revenue cycle process.
Utilizes Payer specific screening tools as a resource to assist in the determination process regarding level of service and medical necessity.
Virtua Health strives to connect individuals to the care they need, building a healthier community in South Jersey. They are a Magnet-recognized health system with over 14,000 colleagues, including over 2,850 doctors, physician assistants, and nurse practitioners.
Acts as the clinical coding subject matter expert and lead coding resource across the organization.
Acts as a resource and provides education to providers on clinical coding standards.
Coordinates and leads the Alliance Coding Workgroup.
Central California Alliance for Health is a regional non-profit health plan that provides accessible, quality health care. The company has over 500 employees and fosters a respectful, diverse, professional, and fun culture where employees are empowered to do their best work.
Responsible for collections and appeals from various Federal, State, & Third Party (HMO, PPO, IPA, TPA Indemnity) payers.
Optimize payment reimbursements by reviewing accounts for billing accuracy and health plan coverage.
Process an appeal, resubmit/rebill, or forward claims for adjudication as necessary.
BillionToOne is a next-generation molecular diagnostics company on a mission to make powerful, accurate diagnostic tests accessible to everyone. Forbes recently named them one of America's Best Startup Employers for 2025, and they were awarded Great Place to Work certification in 2024.
Assist Revenue Cycle Consultant and Technical Consultant teams in the implementation of Experian's Claim Source revenue cycle management system
Review internal process, recommend and develop changes to improve systems efficiency, automation, and effectiveness
Communicate status with team members, end-users and clients within client expectations including participating in regular client calls
Experian is a global data and technology company, powering opportunities for people and businesses around the world. A FTSE 100 Index company listed on the London Stock Exchange (EXPN), they have a team of 23,300 people across 32 countries and were named a World's Best Workplace in 2024.
Processes acute and post-acute inpatient medical or behavioral health and select intensive outpatient higher level of care requests through review of the submitted request and applicable clinical records
Collaborates with UM department staff, including Clinical Support Specialists and Medical Directors to make a final determination, and with Care Management staff on discharge planning and transition of care activities.
Identifies and refers members with complex needs to the appropriate population health and/or care management program.
Capital Blue Cross promises to go the extra mile for our team and our community. Our employees consistently vote us one of the “Best Places to Work in PA, and we foster a flexible environment where your health and wellbeing are prioritized.
Assists with medical record documentation requests and leverages medical management system to initiate case and/or authorization to support clinical processes.
Conducts fax and telephonic outreach; and written communications to members and/or providers to communicate status of UM/CM processes.
Actively participates in supporting department compliance and performance through administrative activities such as report monitoring/distribution, and other tasks as assigned by leadership.
Capital Blue Cross promises to go the extra mile for their team and community. Employees consistently vote it one of the “Best Places to Work in PA”.
The Senior Payer Accounts Receivable Specialist drives payer reimbursement performance and ensures timely, accurate claim resolution. This individual will oversee the payer accounts receivable process across multiple states. This role requires knowledge of healthcare payer operations, denial management, and reimbursement trends.
knownwell is a weight-inclusive healthcare company offering metabolic health services, primary care, nutrition counseling and health coaching services.
The Insurance Reimbursement Specialist maximizes reimbursement by collecting outstanding balances from insurance companies. The Specialist follows up on unresolved claims and escalates claims for reconsiderations. The Specialist works with CareDx Payer Dispute Resolution/Market Access teams ensuring proper reimbursement from payers.
CareDx, Inc. is focused on the discovery, development, and commercialization of clinically differentiated, high-value healthcare solutions for transplant patients.
Perform daily revenue integrity audits and charge reconciliation.
Monitor patient board and review census and discharges.
Collaborate with care providers to resolve missing documentation.
UofL Health is a fully integrated regional academic health system with nine hospitals, four medical centers and nearly 200 physician practice locations.
Maintain comprehensive billing records, monitor and report key performance indicators related to claims submission, denial resolution, and payment posting.
Serve as the primary point of contact for internal teams and external payers.
Apollo Behavior is the premier provider of ABA therapy in metro Atlanta, and the largest ABA provider based in Georgia.
Develop trusting long-term patient relationships and empower you to do the best work of your career. Conduct holistic assessments to identify conditions, functional status and member values. Support chronic disease management, using motivational interviewing techniques.
Devoted Medical was founded on the belief that if we treat each member like we would our loved ones, we can meaningfully improve healthcare experiences.
Support patients through the denial and appeal process.
Coordinate with healthcare providers and insurance companies.
Ensure seamless access to our innovative DME device.
Noctrix Health is redefining the treatment of chronic neurological disorders with clinically validated therapeutic wearables. Their team is dedicated to delivering prescription-grade therapy with an outstanding user experience and has pioneered the world’s first drug-free wearable therapy.
Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement.
Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications.
Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations.
Cohere Health's clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration, cost containment, and healthcare economics. The Coherenauts who succeed here are empathetic and believe diverse, inclusive teams make the most impactful work.
Lead the preparation and submission of comprehensive provider rosters to Managed Medicare, Medicaid, and commercial payers.
Audit internal provider data against database records to ensure 100% accuracy before submission.
Serve as the primary point of contact for health plans to resolve roster discrepancies, rejections, or paneling delays.
Privia Health is a technology-driven, national physician enablement company that collaborates with medical groups, health plans, and health systems. The Privia Platform consists of scalable operations and end-to-end, cloud-based technology that reduces unnecessary healthcare costs.
Establish and direct the strategic vision for the Imagine Pediatrics centralized call center.
Lead a team of engagement associates that enroll attributed eligible patients into the clinical program.
Partner with Product, Engineering, and Data teams to inform the technical infrastructure.
Imagine Pediatrics is a tech-enabled, pediatrician-led medical group reimagining care for children with special health care needs. They deliver 24/7 virtual-first and in-home medical, behavioral, and social care, enhancing existing care teams with compassion and an unwavering commitment.
As the PARS Client Liaison, you will report to Experian Health and manage the partnership between the Payment Appeal Recovery Service (PARS) and the Client. As the primary contact, you will work with Experian Health departments and PARS staff to ensure client satisfaction and Return on Investment. You will present PARS Activity Reviews and Contract Manager Reports to the client throughout the client life cycle.
Experian is a global data and technology company, powering opportunities for people and businesses around the world.